RESUMEN
Choriocarcinomas are uncommon tumors, with non-gestational types occurring in both males and females. Primary choriocarcinoma of the colon is extremely rare. It presents significant diagnostic and therapeutic challenges due to its aggressive nature and poor prognosis, with no cure available, and a mean survival of 8 months. This case report describes a 48-year-old woman who presented with abdominal pain and an ovarian mass, initially suspected to be ovarian cancer. Further workup showed a primary tumor in the colon, with extension to the ovary and liver metastasis. The pathology findings confirmed the presence of colorectal adenocarcinoma with choriocarcinomatous differentiation, as indicated by immunohistochemistry. The patient initially responded to the cisplatin/etoposide regimen; however, she relapsed shortly after. The patient received additional treatments with pembrolizumab, paclitaxel, and olaparib, which resulted in partial remission. Despite challenges during treatment, such as suspected uveitis related to immune-checkpoint inhibitors and potential interference of antibodies with beta-human chorionic gonadotropin (ß-hCG) testing, the patient maintained a good performance status for over 1.5 years after being diagnosed. The case emphasizes the difficulties in treating choriocarcinomas, primarily because of their aggressiveness and the absence of standardized therapy. Our goal with this case is to draw multidisciplinary attention to this rare condition. Further studies are necessary to comprehend its clinical characteristics, prognosis factors, molecular markers, and treatment approaches. Such studies may be crucial in establishing targeted and personalized therapy. LEARNING POINTS: Primary choriocarcinoma of the colon is rare and often misdiagnosed due to its atypical presentation, complicating timely and accurate diagnosis.The aggressive nature of this tumor and lack of standardized therapy necessitates a multidisciplinary approach and personalized treatment plans, especially following relapse.Molecular profiling guided the use of immunotherapy, which showed potential but also presented challenges, highlighting the need for further research in treating this rare malignancy.
RESUMEN
Colorectal cancer (CRC) presents significant mortality risks, underscoring the urgency of timely diagnosis and intervention. Advanced stages of CRC are managed through chemotherapy, targeted therapy, immunotherapy, radiotherapy, and surgery. Immunotherapy, while effective in bolstering the immune system against cancer cells, often carries toxic side effects, including colitis. This study aimed to evaluate the incidence of colitis in patients with metastatic CRC (mCRC) undergoing various immunotherapy treatments. Through a systematic search of Google Scholar and PubMed databases from inception until November 2023, nine relevant studies were identified. Subgroup analyses revealed a higher incidence of colitis, particularly in patients treated with anti-cytotoxic T-lymphocyte-associated molecule-4 (anti-CTLA-4) and combination therapies compared to monotherapy with programmed cell death receptor-1 (PD-1) or programmed cell death ligand receptor-1 (PDL-1) inhibitors. Notably, naive-treated metastatic CRC patients exhibited elevated colitis incidences compared to those previously treated. In conclusion, anti-CTLA-4 and combination therapies, such as nivolumab plus ipilimumab, were associated with increased colitis occurrences in metastatic CRC patients, highlighting the need for vigilant monitoring and management strategies, especially in immunotherapy-naive individuals.
RESUMEN
The novel coronavirus disease (COVID-19) pandemic caused by the SARS-CoV-2 virus started in December 2019 in the city of Wuhan, in China's Hubei province. This virus quickly spread worldwide, and on March 11, 2020, it was declared a pandemic. Thrombosis, as a hallmark of severe disease, was recognized early as a cause of death; however, the exact pathophysiological mechanism is still not fully understood. We are reporting the case of a 46-year-old patient who presented with multiple arterial thromboses in the setting of an acute COVID-19 infection requiring systemic thrombolytic therapy and thrombectomy.
RESUMEN
La Diabetes mellitus de aparición post trasplante renal, es una de las complicaciones más comunes para el paciente que se somete a este procedimiento, que además se relaciona con aumento en las complicaciones infecciosas, cardiovasculares y empeora las tasas de supervivencia. La adecuada comprensión sobre los mecanismos que llevan al desarrollo de diabetes postrasplante renal son de vital importancia ya que se ha logrado evidenciar a través de diversos estudios, el impacto que estos tienen en la supervivencia del injerto y del paciente. El objetivo de este trabajo fue determinar la relación entre el índice de masa corporal pre trasplante renal, ganancia de peso en los primeros tres meses y al año post trasplante renal, además de tipo de esquema inmunosupresor postrasplante renal con el desarrollo de diabetes mellitus en pacientes post trasplante renal en la consulta externa de endocrinología en el servicio de trasplante renal del instituto salvadoreño del seguro social en el periodo de enero 2015 a diciembre 2018, mediante un estudio correlacional, analítico transversal, determinado si existe la relación entre estas variables en nuestra población. Sin embargo, al proceder con la fase de revisión documental pudimos evidenciar de que no se lleva un registro en los expedientes de las variables que este estudio debía procesar, por tanto, esto se considera una oportunidad de mejora para que nuestra investigación permita identificar estos vacíos de procedimiento que son determinantes en la evolución clínica de los pacientes y tener fundamento y evidencia para emitir recomendaciones que permitan superar esta situación en beneficio de los pacientes en el programa
